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Title: Clinical presentations, diagnosis, mortality and prognostic markers of tuberculous meningitis in Vietnamese children: A prospective descriptive study
Authors: Nguyen Duc Bang
Maxine Caws
Thai Thanh Truc
Tran Ngoc Duong
Nguyen Huy Dung
Dang Thi Minh Ha
Guy E. Thwaites
Doortje Heemskerk
Joel Tarning
Laura Merson
Pham Van Toi
Jeremy J. Farrar
Marcel Wolbers
Thomas Pouplin
Jeremy N. Day
Oxford University Clinical Research Unit
Pham Ngoc Thach Hospital
Liverpool School of Tropical Medicine
Nuffield Department of Clinical Medicine
Mahidol University
Keywords: Medicine
Issue Date: 18-Oct-2016
Citation: BMC Infectious Diseases. Vol.16, No.1 (2016)
Abstract: © 2016 The Author(s). Background: Tuberculous meningitis in adults is well characterized in Vietnam, but there are no data on the disease in children. We present a prospective descriptive study of Vietnamese children with TBM to define the presentation, course and characteristics associated with poor outcome. Methods: A prospective descriptive study of 100 consecutively admitted children with TBM at Pham Ngoc Thach Hospital, Ho Chi Minh City. Cox and logistic regression were used to identify factors associated with risk of death and a combined endpoint of death or disability at treatment completion. Results: The study enrolled from October 2009 to March 2011. Median age was 32.5months; sex distribution was equal. Median duration of symptoms was 18.5days and time from admission to treatment initiation was 11days. Fifteen of 100 children died, 4 were lost to follow-up, and 27/81 (33%) of survivors had intermediate or severe disability upon treatment completion. Microbiological confirmation of disease was made in 6%. Baseline characteristics associated with death included convulsions (HR 3.46, 95CI 1.19-10.13, p=0.02), decreased consciousness (HR 22.9, 95CI 3.01-174.3, p<0.001), focal neurological deficits (HR 15.7, 95CI 1.67-2075, p=0.01), Blantyre Coma Score (HR 3.75, 95CI 0.99-14.2, p<0.001) and CSF protein, lactate and glucose levels. Neck stiffness, MRC grade (children aged >5years) and hydrocephalus were also associated with the combined endpoint of death or disability. Conclusions: Tuberculous meningitis in Vietnamese children has significant mortality and morbidity. There is significant delay in diagnosis; interventions that increase the speed of diagnosis and treatment initiation are likely to improve outcomes.
ISSN: 14712334
Appears in Collections:Scopus 2016-2017

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